WHAT WE'RE LOOKING FORBerkshire Hathaway Homestate Companies, Workers Compensation Division, has an opening in our Omaha, Nebraska office for a Utilization Review Nurse. The Utilization Review Nurse is responsible for applying clinical expertise in reviewing requests for the authorization of medical treatment for injured workers, verifying medical appropriateness and ensures all aspects of an injured worker’s treatment are effective, efficient, and in accordance with applicable legal requirements. This individual will work closely with Utilization Review Specialists, the Medical Bill Review team, and Claims staff to ensure effective and efficient integrated management of treatment. This is a full-time, permanent position within our Medical Management team and that will allow experienced nurses to put their years of clinical knowledge to use in an office environment and learn new skills in this growing industry. No prior Utilization Review experience is required.
ESSENTIAL RESPONSIBILITIES
- Dispositions pending authorization requests that could not be approved by the Specialist team in alignment with State regulations, accepted treatment and Company guidelines. Performs a thorough review, ensuring appropriate documentation to facilitate timely response for those requests requiring determination by peer review physician.
- Reviews reconsiderations, internal appeals, concurrent reviews, and retrospective reviews as assigned in accordance with State regulations, accepted treatment and Company guidelines.
- Seeks to ensure that injured workers receive medical care that is safe, efficient, appropriate, and effective for their compensable work injuries.
- Gains and maintains a deep understanding of medical treatment guidelines, including ODG and ACOEM, and how those guidelines impact regulatory policy for various states.
- Fosters a positive working relationship with other Company staff, including Claims Adjusting, Nurse Case Management, Special Investigations, Claims Legal, Lien Unit, Client Services, and the Call Center.
- Maintains patient confidentiality and safeguards protected health information in accordance with State and Federal regulations and Company policy.
- Inquires with medical providers regarding clarification for authorization requests and coordinates communication with Claims Adjusting staff and others as necessary regarding treatment for injured workers.
- Ensures clear, concise, and accurate comments and information regarding diagnosis, treatment, care plans, decisions, and recommendations are documented timely within appropriate file/system.
- Ensures that appropriate notices are forwarded to medical providers, injured workers, Claims staff, and attorneys in connection with each determination,
REQUIRED QUALIFICATIONS
- EDUCATION: Bachelor of Science Nursing degree (BSN), Associate Degree in Nursing (ADN), or Registered Nursing degree (RN) from four-year college or university or an accredited college.
- LICENSES/CERTIFICATIONS: Nursing/RN - Registered Nurse - State Licensure and/or Compact State Licensure required; must be current and in good standing.
- EXPERIENCE: A minimum of five (5) years of nursing experience required, hospital nursing experience preferred.
- TECHNICAL SKILLS: Knowledge of current recognized evidence-based medicine guidelines, office operations, workflow analysis, and current technologies in telecommunications, data entry, and file management. Proficiency in Microsoft Office software and able to quickly master proprietary and vended software applications.
WHAT WE OFFER
- Work-Life Balance
- Work From Home Program (up to 2 days per week)
- Office Within Walking Distance of The Old Market
- Free On-Site Fitness Facility
- Garage Parking
BENEFITS
- Paid Time Off
- Paid Holidays
- Retirements Savings Match
- Group Health Insurance (Medical, Dental, and Vision)
- Life and AD&D Insurance
- Long Term Disability Insurance
- Accident and Critical Illness Insurance
- Flexible Savings Accounts
- Paid Community Volunteer Day
- Employee Assistance Program
- Tuition Reimbursement Program
- Employee Referral Program
- Diversity, Equity and Inclusion Program
Job Type: Full-time
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Disability insurance
- Employee discount
- Flexible schedule
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Referral program
- Tuition reimbursement
- Vision insurance
Healthcare setting:
- Acute care
- ER
- Hospital
- Inpatient
- Outpatient
Medical specialties:
- Critical & Intensive Care
- Medical-Surgical
- Surgery
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
Experience:
- Nursing: 5 years (Required)
License/Certification:
Ability to Commute:
- Omaha, NE 68102 (Required)
Ability to Relocate:
- Omaha, NE 68102: Relocate before starting work (Required)
Work Location: Hybrid remote in Omaha, NE 68102